Obesity: Disease or Decision?

Lutheran Bariatric Center offers the newest surgical treatments.

2/1/2017

Jennifer L. Boen

Jeffrey Crane & provided

If shedding excess pounds and keeping them off seems an elusive goal, you are not alone. One in three Americans is obese, meaning they have a body mass index (BMI) of 30 or more. Many are weighed down not just by pounds but by guilt, frustration, isolation and a host of serious medical conditions related to obesity. Among the most common: type 2 diabetes; hypertension and other cardiovascular diseases; increased cancer risk; infertility; liver and gallbladder disease; orthopedic problems; and sleep apnea.

“Obesity is not a choice; it is a disease,” says Dr. Dale Sloan, surgical medical director of the Lutheran Bariatric Center, the area’s only accredited bariatric center. Both surgical and non-surgical weight loss programs are available.

In 2013, the American Medical Association pronounced obesity “a disease state with multiple pathophysiological aspects requiring a range of interventions to advance obesity treatment and prevention.”

It’s time people stop thinking about obesity as extra pounds that people are not trying hard enough to shed, Sloan says, noting, “It’s like telling someone with cancer you need to stop having cancer. With someone who is 100 pounds overweight, it’s not as simple as just saying, ‘Stop eating.’ ”

Surgery is an option for those with a BMI of 35 or higher and who meet other criteria. Though bariatric surgery is as safe as having your gallbladder removed, it is “not the easy way out,” Sloan said. Patients must meet with behaviorists, dietitians and exercise specialists both before and after surgery.

Between 2005 and 2016, just over 1,400 weight-loss surgeries were done at Lutheran Bariatric Center. Among the patients was Alta McNeal, 64, who in 2014 had bariatric surgery after seeing her type 2 diabetes worsening.

“My medicine just kept increasing,” recalls the Fort Wayne Community Schools executive secretary. Though several surgical options are available at the center, Sloan recommended McNeal have sleeve gastrectomy, also known as gastric sleeve. About 80 percent of the stomach is removed, with a tube-shaped portion, or sleeve, left that remains connected to the small intestine. It reduces food capacity of the stomach and removes the portion of the stomach where the hunger hormone ghrelin is made.

Gastric sleeve is both low risk and highly effective, Sloan says. McNeal lost 62 pounds following surgery and has kept it off but is quick to point out, “I did it for my health.” She no longer has diabetes and takes no medications.

Father Jacob Meyer is another successful patient of the center, losing over 200 pounds. “The program has given me the skills I need to be a better servant to those I love,” he says.

A better understanding of obesity’s complex causation – hunger hormones, psychosocial factors, metabolism, genetics – has led to more effective treatments. The Lap-Band was initially thought to be a good solution. A band, placed around the top of the stomach, is inflated with saline over time to make a small stomach pouch. It was thought the walls of the full pouch would send signals to the brain to curb appetite, “but there were problems with the Lap-Band and effectiveness,” Sloan says. A high percentage of patients failed to lose at least half of the excess body weight. The part of the stomach where hunger hormones are made was not impacted. Other issues such as band slippage required additional surgery.

Sloan stopped doing the Lap-Band when more effective, yet safe procedures evolved. Today, 60 percent of his surgeries are gastric sleeve; about 30 percent are Roux-en-Y gastric bypass. With the latter, a small pouch is created out of the upper stomach; it is connected directly to the middle portion of the small intestine, bypassing the rest of the stomach and the upper part of the small intestine. The Roux-en-Y is usually the best option for individuals with severe gastric reflux, Sloan says. Both procedures are done laparoscopically.

The newest surgical option at Lutheran is the single anastomosis duodenal switch. It is also called SIPS for stomach intestinal pylorus-sparing. This procedure is a combination of gastric sleeve along with bypass of all but approximately 10 feet of the small intestine, Sloan explains, adding, “This is a very good option for people with more severe diabetes as there is a high cure rate and the greatest long-term weight loss. Insurance companies generally cover the standard duodenal switch, but may not cover SIPS because it is a newer procedure.”

Denial for coverage remains an issue overall, Sloan says, noting, “Do you know how many people die from breast cancer each year? About 40,000. Yet 300,000 to 400,000 people die each year from complications of obesity.”